Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk

Anurag Mehta; Nestor Vasquez; Colby R. Ayers; Jaideep Patel; Ananya Hooda; Amit Khera; Roger S. Blumenthal; Michael D. Shapiro; Carlos J. Rodriguez; Michael Y. Tsai; Laurence S. Sperling; Salim S. Virani; Michael J. Blaha; Parag H. Joshi

doi:10.1016/j.jacc.2021.11.058

Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk

Anurag Mehta, Nestor Vasquez, Colby R. Ayers, Jaideep Patel, Ananya Hooda, Amit Khera, Roger S. Blumenthal, Michael D. Shapiro, Carlos J. Rodriguez, Michael Y. Tsai, Laurence S. Sperling, Salim S. Virani, Michael J. Blaha, Parag H. Joshi

Laboratory Medicine and Pathology

Research output: Contribution to journal › Article › peer-review

41 Scopus citations

Abstract

Background: Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. Objectives: This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. Methods: Plasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor–adjusted Cox regression models. Results: Among MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. Conclusions: Lp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.

Original language	English (US)
Pages (from-to)	757-768
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	79
Issue number	8
DOIs	https://doi.org/10.1016/j.jacc.2021.11.058
State	Published - Mar 1 2022

Bibliographical note

Funding Information:
The authors thank the other investigators, the staff, and the participants of the MESA and DHS studies for their valuable contributions. A full list of participating MESA study investigators and institutions can be found at online.

Publisher Copyright:
© 2022 American College of Cardiology Foundation

Keywords

atherosclerotic cardiovascular disease
coronary artery calcium
lipoprotein(a)
primary cardiovascular disease prevention

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1016/j.jacc.2021.11.058

Find It

Find It at U of M Libraries

Cite this

Mehta, A., Vasquez, N., Ayers, C. R., Patel, J., Hooda, A., Khera, A., Blumenthal, R. S., Shapiro, M. D., Rodriguez, C. J., Tsai, M. Y., Sperling, L. S., Virani, S. S., Blaha, M. J., & Joshi, P. H. (2022). Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk. Journal of the American College of Cardiology, 79(8), 757-768. https://doi.org/10.1016/j.jacc.2021.11.058

Mehta, A, Vasquez, N, Ayers, CR, Patel, J, Hooda, A, Khera, A, Blumenthal, RS, Shapiro, MD, Rodriguez, CJ, Tsai, MY, Sperling, LS, Virani, SS, Blaha, MJ & Joshi, PH 2022, 'Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk', Journal of the American College of Cardiology, vol. 79, no. 8, pp. 757-768. https://doi.org/10.1016/j.jacc.2021.11.058

@article{c3254615fad042a380ab19e9c31e7a62,

title = "Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk",

abstract = "Background: Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. Objectives: This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. Methods: Plasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor–adjusted Cox regression models. Results: Among MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. Conclusions: Lp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.",

keywords = "atherosclerotic cardiovascular disease, coronary artery calcium, lipoprotein(a), primary cardiovascular disease prevention",

author = "Anurag Mehta and Nestor Vasquez and Ayers, {Colby R.} and Jaideep Patel and Ananya Hooda and Amit Khera and Blumenthal, {Roger S.} and Shapiro, {Michael D.} and Rodriguez, {Carlos J.} and Tsai, {Michael Y.} and Sperling, {Laurence S.} and Virani, {Salim S.} and Blaha, {Michael J.} and Joshi, {Parag H.}",

note = "Funding Information: The authors thank the other investigators, the staff, and the participants of the MESA and DHS studies for their valuable contributions. A full list of participating MESA study investigators and institutions can be found at online. Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = mar,

day = "1",

doi = "10.1016/j.jacc.2021.11.058",

language = "English (US)",

volume = "79",

pages = "757--768",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "8",

}

TY - JOUR

T1 - Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk

AU - Mehta, Anurag

AU - Vasquez, Nestor

AU - Ayers, Colby R.

AU - Patel, Jaideep

AU - Hooda, Ananya

AU - Khera, Amit

AU - Blumenthal, Roger S.

AU - Shapiro, Michael D.

AU - Rodriguez, Carlos J.

AU - Tsai, Michael Y.

AU - Sperling, Laurence S.

AU - Virani, Salim S.

AU - Blaha, Michael J.

AU - Joshi, Parag H.

N1 - Funding Information: The authors thank the other investigators, the staff, and the participants of the MESA and DHS studies for their valuable contributions. A full list of participating MESA study investigators and institutions can be found at online. Publisher Copyright: © 2022 American College of Cardiology Foundation

PY - 2022/3/1

Y1 - 2022/3/1

N2 - Background: Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. Objectives: This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. Methods: Plasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor–adjusted Cox regression models. Results: Among MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. Conclusions: Lp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.

AB - Background: Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. Objectives: This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. Methods: Plasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor–adjusted Cox regression models. Results: Among MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. Conclusions: Lp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.

KW - atherosclerotic cardiovascular disease

KW - coronary artery calcium

KW - lipoprotein(a)

KW - primary cardiovascular disease prevention

UR - http://www.scopus.com/inward/record.url?scp=85124410787&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85124410787&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2021.11.058

DO - 10.1016/j.jacc.2021.11.058

M3 - Article

C2 - 35210030

AN - SCOPUS:85124410787

SN - 0735-1097

VL - 79

SP - 757

EP - 768

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 8

ER -

Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this